Provider Demographics
NPI:1043841976
Name:ASPIRE WELLNESS CENTRE OF TEXAS LLC
Entity Type:Organization
Organization Name:ASPIRE WELLNESS CENTRE OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELEON
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:210-977-0070
Mailing Address - Street 1:7300 BLANCO RD STE 503
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4941
Mailing Address - Country:US
Mailing Address - Phone:210-977-0070
Mailing Address - Fax:
Practice Address - Street 1:7300 BLANCO RD STE 503
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4941
Practice Address - Country:US
Practice Address - Phone:210-977-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service